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What Are Root Canals?

It may surprise you to learn that root canals were performed over two thousand years ago and all those people died! It must have been the root canals that killed them….

It is possible that everyone who’s ever had a root canal died because of it- but it’s highly unlikely. It would be like saying, “everyone who has ever worn Nike shoes has died, so it must be the Nike shoes killing people around the world.” That blanket statement pretty much summarizes the dental industry’s most elusive procedure.

Science is awesome because it relies on a scientific method. Though that process was not used when making the generalization in the root canal story. Why is that? Why do root canals have such a bad reputation? Follow the money? I think so. Let us dissect this topic one concept at a time.

First, we need a dentist to analyze both the number and shape of all canals in a tooth, which can be achieved by capturing an x-ray of the tooth’s anatomy on a 3D CAT scan. Many dentists, especially big dental corporations, do not splurge on up-to-date technology when there is no financial turnover. For instance, some dentists are still using monomer based acrylic (like the kind used in nail salons) during their surgical implant treatments, even though PMMA has been around for a couple of decades.

Root canals are meant to create a sterile environment inside the tooth’s root and that has been almost impossible up to recent times. It takes a lot of costly technology and many years of experience to do a proper root canal, and the current insurance reimbursements/fees certainly are going the other way (i.e. lowering reimbursements in presence of high inflation). That’s a recipe for a disaster!

Secondly, the various ways to irrigate all the horizontal and microscopic canals is only effective if the dentist has the proper equipment and experience.

Not all dentists like to invest in equipment. Let’s face it…most prefer to take their family on a European vacation before they invest in a $200,000 system. Though costly, it certainly pays to invest in these technologies as they are designed to make a dentist’s job more efficient- allowing patients to have quality treatment.

Now, you may be wondering how we know then if our root canal has been performed properly. Is it the absence of pain and lack of changes on the x-ray that defines its success? According to current standards- yes.

Why will I forever defend them?

In my 30 years of being a dentists, I have seen many healthy 100 year old patients walking around with root canals that have been completed over 50 years ago. Just like with everything else, it’s HOW THEY ARE DONE! It is possible that their bad reputation has everything to do with the “new kid on the block” called a dental implant; which is ten times more profitable than any root canal.

The negative narrative of root canals killing people has been convenient to all dentists who do not invest in technology or do not have the experience and aptitude to do them properly.

Let us for a minute set the issue of cost aside and only consider what’s best for the patient.

What options does one have when struck by a broken tooth or decay infecting the pulp? I know all we want is a filling but when the nerve is exposed or infected, a filling is no longer an option as the tooth accumulates a lot of bacteria that are anaerobic. Anaerobic bacteria do not like oxygen, and if not irrigated out, will slowly grow inside the tooth causing a low grade asymptomatic infection. This is undesirable as it will eventually lead to further treatment.

When a tooth hurts or is non vital simply due to its age

There are only 3 options in this scenario:

1. Root canal to remove the painful nerve and keep the tooth for decades.

2. Extract the tooth and explore replacement options.

3. Extract the tooth and do nothing.

The 3rd option is not the best idea for many reasons. A front tooth missing often results in low self esteem. A back tooth missing will cause teeth shifting, ultimately leading to its loss.

If one has any jaw joint problems, then losing a back tooth (which all help maintain the jaw in proper position) a patient may develop referred pain in their neck, back, legs, or feet without knowing it’s related to tooth loss.That is one of the reasons why orofacial pain became the 11th specialty of dentistry last year.

Replacement options:

A removable partial denture moves around and accumulates billions of food particle bacteria and fungus which, according to research, is not any better than where we started.

Is it better to have an implant? A foreign body made out of titanium- as the zirconia implants do not provide enough strength for back teeth. How is the implant any less invasive than a root canal? Has anyone considered the amount of pathogens present at the interface of the implant screw? Not to mention the fact that implants are commonly placed in close approximation to roots of other teeth. How is that ok? Simple answer is that it is not.

TMJ Specialist and Airway

Strangely enough all dentists who have been up to now calling themselves TMJ dentists will be grandfathered in without having to go through the newly required 2 additional years of additional school, but instead they will be encouraged to familiarize themselves with new protocol. This is how desperate dentistry is to hopefully reveal the real reason for keeping your teeth for life- that being your AIRWAY.

Our mouths need teeth not just for aesthetics, speaking and chewing successfully, but also to maintain a certain oral volume which decreases with each consecutive loss of a tooth.

The bite collapses within minutes of a tooth being removed, and if you like drama, that can kill you; only because that can make just enough of a difference in your airways, especially if you are already a mouth breather.

Since none of it is ultimately convincing to skeptical readers: how do we prevent a root canal?

It’s all about not allowing inflammatory cells to suffocate the pulp right after any dental procedure. In addition to taking long lasting antiinflammatories, like Aleve, one must hydrate as teeth are generally the least vascularized entities in our bodies. The time of biggest inflammation that’s most damaging to a healing pulp is roughly 72 hours post treatment. I have found in my 30 years of being a dentist that teeth heal well without root canals if the patient follows our post operative instructions. Some believe that if the tooth does not hurt within a few days after the procedure that it will heal. Unfortunately that’s the time when it’s most vulnerable and the evidence of pulpal damage is not apparent for a few months after the filling.

So if you have a dentist who claims they know how to do a root canal well and they have the equipment, experience, and technology to make it successful then maybe it’s not a bad choice considering the alternatives.

Asha Laraway